Isolated Bilateral Pyramidal Tract Lesions? An Unusual Case of Demyelination following Trauma

Abstract

This paper describes the case of a young woman who developed quadriparesis due to isolated bilateral pyramidal tract lesions suggestive of demyelination following trauma.

Reversible post-traumatic bilateral extensive restricted diffusion of the brain. A case study and review of the literature

“…High signal intensity at DWI and low ADC values were observed 12 days later and reversed to normal 8 days later on. A more recent paper [46] has described a case of reversible restricted diffusion of both pyramidal tracts, which has been correlated to post-traumatic demyelinaton, most likely resulting from contusion injury of the pons and medulla with the clivus.…”

Reversible restricted-diffusion lesion representing transient intramyelinic cytotoxic edema in a patient with traumatic brain injury

“…However, the changes on DWI-MRI of this eight-year old girl have resolved completely with no residual imaging abnormalities in follow-up scanning. An interesting note is the involvement of the corpus callosum in most of these cases, except for the case reported by Muttikkal et al 6 All of the scans show complete resolution after clinical stabilization. This finding emphasizes that the NMDA-receptors are abundant in the corpus callosum leading to the expected sequel of intracellular calcium entry.…”

“…4 Muttikkal and his colleagues reported reversible diffusion weighted abnormalities in a 27-year-old female two weeks following trauma. 6 These changes were attributed to demyelination either due to the trauma itself or following brain edema. Variant osmotic myelinolysis was proposed as a third possibility.…”

“…Variant osmotic myelinolysis was proposed as a third possibility. 6 The most recent case of reversible white matter restricted diffusion abnormalities following traumatic brain injury was an 18-year old male whose MRI showed cytotoxic edema in the subcortical white matter of bilateral centrum semiovali and in the splenium of corpus callosum. 3…”